Long-term outcomes of percutaneous nephrolithotomy in 502 chronic kidney disease patients: insights from a tertiary center.

INTRODUCTION

Urinary stone disease is a significant risk factor for chronic kidney disease. Percutaneous nephrolithotomy is the standard treatment for complex renal stones, yet its long-term effects on renal function in such patients remain underexplored. This study evaluates the outcomes, complications, and factors influencing percutaneous nephrolithotomy success in chronic kidney disease patients.

MATERIALS AND

METHODS

This single-center study included 502 chronic kidney disease patients undergoing percutaneous nephrolithotomy between March 2019 and April 2024. Outcomes assessed were changes in effective glomerular filtration rate, stone-free rates, complications (Clavien-Dindo classification), and mortality. Preoperative, intraoperative, and postoperative parameters were analyzed, and follow-up outcomes were recorded and analyzed.

RESULTS

The cohort's mean age was 47.25 ± 13.48 years, with 65.9% males. Complete stone clearance was achieved in 89.28%, with an operative time of 95.05 ± 29.47 min. Complications occurred in 28%, primarily urosepsis (12.79%), urinary tract infections (9.6%), and bleeding (4.6%). Effective glomerular filtration rate improved significantly postoperatively (63.97 ± 24.01 to 84.40 ± 26.87 mL/min/1.73 m²). At a median follow-up of 20.01 months, 50.8% of patients showed stage improvement, while 7% experienced deterioration. The stone-free rate was 90.2%, with a recurrence rate of 4.38%. Mortality was 3.6%, primarily in Stage 5 patients.

CONCLUSION

Percutaneous nephrolithotomy is effective in managing renal stones in chronic kidney disease patients, improving or stabilizing renal function in most cases. While complications are higher in this population, careful preoperative planning and surgical techniques optimize outcomes. Further research is needed to refine protocols and patient selection.